Family Medicine Prometric exam questions

The Family Medicine exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Family Medicine practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Cardiovascular Medicine

   A 70-year-old man with long-standing type 2 diabetes has a non-healing ulcer on the lateral border of his left foot and night pain relieved by hanging the leg out of bed. His ankle-brachial index is measured at 1.35. How should this result be interpreted?

   1. AIt excludes significant peripheral arterial disease and the ulcer is purely neuropathic
   2. BIt is falsely elevated by medial arterial calcification, and toe-brachial index or toe pressures should be measured
   3. CIt indicates severe aortic regurgitation causing a wide pulse pressure
   4. DIt confirms critical limb ischaemia without further testing
   Show answer and explanation

   Correct answer: B. It is falsely elevated by medial arterial calcification, and toe-brachial index or toe pressures should be measured

   An ankle-brachial index above 1.4 (and values in the 1.3-1.4 range in diabetes or chronic kidney disease) suggests incompressible, medially calcified vessels, so a normal or high value cannot exclude ischaemia; toe-brachial index, toe pressures or duplex imaging are required. Rest pain relieved by dependency plus tissue loss strongly suggests chronic limb-threatening ischaemia, so attributing the ulcer solely to neuropathy would delay revascularisation. Aortic regurgitation does not produce a spuriously high ankle index in this way.

   Reference: 2024 ESC Guidelines for the Management of Peripheral Arterial and Aortic Diseases; Global Vascular Guidelines on Chronic Limb-Threatening Ischemia (2019)

2. Question 2 · Preventive Medicine, Screening, Health Promotion and Community Health

   A 35-year-old expatriate attends with insomnia and dyspepsia. He completes the 10-item Alcohol Use Disorders Identification Test (AUDIT) and scores 13. He has no features of withdrawal, no morning drinking, normal liver enzymes and no evidence of dependence on assessment. What is the most appropriate management?

   1. ANo action, as a score below 16 is within normal limits
   2. BDeliver a structured brief intervention with feedback and goal setting, and arrange follow-up
   3. CRefer immediately for inpatient medically assisted withdrawal
   4. DStart disulfiram and review in one month
   Show answer and explanation

   Correct answer: B. Deliver a structured brief intervention with feedback and goal setting, and arrange follow-up

   An AUDIT score of 8-15 identifies hazardous drinking, for which simple structured advice (personalised feedback, information on risks, agreed goals and follow-up) is the evidence-based response and reduces consumption meaningfully. Scores below 8 indicate low risk, 16-19 warrant brief counselling with continued monitoring, and 20 or above prompt diagnostic evaluation for dependence; inpatient withdrawal and relapse-prevention pharmacotherapy such as disulfiram are inappropriate in a non-dependent drinker.

   Reference: Babor TF et al. AUDIT: The Alcohol Use Disorders Identification Test - Guidelines for Use in Primary Care, 2nd ed, WHO (2001); NICE PH24 Alcohol-use disorders: prevention (2010)

3. Question 3 · Respiratory Medicine and Otolaryngology

   A 19-year-old man treated in your clinic for an asthma attack has received three doses of nebulised salbutamol over one hour. He is now drowsy, the chest is quiet on auscultation, SpO2 is 89% on high-flow oxygen and an arterial blood gas shows PaCO2 of 5.9 kPa (44 mmHg) with a pH of 7.32. Which feature most strongly indicates imminent respiratory failure?

   1. AThe loud polyphonic wheeze expected at this stage
   2. BThe normal-range PaCO2 in a patient with severe acute asthma
   3. CThe heart rate of 120 beats per minute
   4. DThe oxygen requirement to maintain saturations above 90%
   Show answer and explanation

   Correct answer: B. The normal-range PaCO2 in a patient with severe acute asthma

   In acute severe asthma hyperventilation should produce hypocapnia; a normal or rising PaCO2 signifies that the patient can no longer sustain the work of breathing and is a near-fatal asthma feature requiring immediate critical care involvement. A quiet chest and drowsiness are also life-threatening signs, whereas an audible wheeze actually indicates continuing air movement. Tachycardia and an oxygen requirement are non-specific and occur in many moderate attacks.

   Reference: British Thoracic Society / SIGN British Guideline on the Management of Asthma (BTS/SIGN 158, 2019), near-fatal asthma criteria

4. Question 4 · Child and Adolescent Health

   A 14-year-old boy presents with 3 hours of sudden, severe left scrotal pain that woke him from sleep, associated with nausea and vomiting. The left testis is exquisitely tender, high-riding and lies horizontally, the cremasteric reflex is absent, and elevating the testis does not relieve the pain. There is no dysuria or urethral discharge. What is the most appropriate management?

   1. AImmediate referral for emergency scrotal exploration, without waiting for imaging
   2. BArrange a Doppler ultrasound of the scrotum within 24 hours and review the result
   3. CStart oral ciprofloxacin for presumed epididymo-orchitis and review in 48 hours
   4. DGive analgesia, provide scrotal support and review in the morning
   Show answer and explanation

   Correct answer: A. Immediate referral for emergency scrotal exploration, without waiting for imaging

   Testicular torsion is a clinical diagnosis and a surgical emergency: testicular salvage exceeds 90% if detorsion occurs within 6 hours but falls sharply thereafter, so this boy must go straight for exploration and bilateral orchidopexy. Doppler ultrasound may be falsely reassuring and must never delay surgery when the clinical picture is typical. Epididymo-orchitis is rare in this age group without sexual activity or urinary symptoms and typically has a preserved cremasteric reflex with pain relief on elevation (Prehn sign), and any delay for review overnight is likely to cost the testis.

   Reference: European Association of Urology Guidelines on Paediatric Urology (2024); AUA/EAU consensus on acute scrotum management

5. Question 5 · Acute and Emergency Care, Minor Surgery and Procedural Skills

   A 26-year-old man who has never received rabies vaccine is bitten by a stray dog while travelling; the bite has broken the skin on his forearm and is bleeding, and the animal cannot be traced. What constitutes correct post-exposure management?

   1. AWound closure with sutures and rabies vaccine alone, since immunoglobulin is only for head and neck bites
   2. BObserve for 10 days and vaccinate only if symptoms develop
   3. CRabies immunoglobulin alone, as vaccine is ineffective once exposure has occurred
   4. DWash the wound with soap and running water for at least 15 minutes, apply an antiseptic, and give rabies immunoglobulin infiltrated into and around the wound plus a full course of rabies vaccine
   Show answer and explanation

   Correct answer: D. Wash the wound with soap and running water for at least 15 minutes, apply an antiseptic, and give rabies immunoglobulin infiltrated into and around the wound plus a full course of rabies vaccine

   A transdermal bite is a WHO category III exposure, requiring immediate thorough wound washing for about 15 minutes, rabies immunoglobulin infiltrated into and around the wound, and a complete course of rabies vaccine in a previously unvaccinated person. Waiting for symptoms is fatal, since rabies is virtually always fatal once clinical disease begins. Immunoglobulin gives immediate passive protection but must be combined with vaccine to generate active immunity, and primary suturing should be delayed or avoided so that infiltration and drainage are not compromised.

   Reference: WHO Expert Consultation on Rabies, Third Report, 2018; WHO Rabies vaccines position paper, 2018

6. Question 6 · Gastroenterology, Hepatology and Nutrition

   A 70-year-old man with a previous open appendicectomy presents with 2 days of colicky central abdominal pain, bilious vomiting, marked distension and no passage of flatus. The abdomen is tympanic with high-pitched bowel sounds and no peritonism. What is the most appropriate immediate action in primary care?

   1. AGive a stimulant laxative and arrange review the following day
   2. BArrange emergency hospital admission for intravenous fluids, nasogastric decompression and surgical assessment
   3. CPrescribe oral metoclopramide and oral rehydration solution
   4. DRequest an outpatient CT colonography within 2 weeks
   Show answer and explanation

   Correct answer: B. Arrange emergency hospital admission for intravenous fluids, nasogastric decompression and surgical assessment

   Colicky pain, vomiting, distension and absolute constipation in a patient with prior abdominal surgery indicate mechanical small bowel obstruction, most often from adhesions, requiring emergency admission for resuscitation, nasogastric decompression and surgical assessment with imaging. Laxatives and prokinetics such as metoclopramide are contraindicated in mechanical obstruction and may precipitate perforation. Outpatient imaging introduces a dangerous delay when strangulation and ischaemia are possible.

   Reference: Bologna Guidelines for diagnosis and management of adhesive small bowel obstruction (World J Emerg Surg, 2018)

7. Question 7 · Dermatology

   A 67-year-old man presents on day 2 of a painful vesicular eruption in a band over the right forehead and upper eyelid that does not cross the midline. There are vesicles on the tip and side of his nose. He denies visual symptoms. What is the most appropriate management?

   1. ATopical aciclovir cream to the affected skin and reassurance
   2. BOral prednisolone alone to reduce the risk of post-herpetic neuralgia
   3. CStart high-dose oral antiviral therapy immediately and arrange same-day ophthalmology assessment
   4. DWithhold antivirals because presentation is beyond 24 hours and prescribe analgesia only
   Show answer and explanation

   Correct answer: C. Start high-dose oral antiviral therapy immediately and arrange same-day ophthalmology assessment

   This is herpes zoster ophthalmicus, and vesicles on the tip or side of the nose (Hutchinson sign) indicate nasociliary nerve involvement with a high risk of keratitis, uveitis and sight loss, so urgent ophthalmology assessment is required even without current visual symptoms. High-dose oral antiviral therapy should start as soon as possible and remains worthwhile when begun within 72 hours of rash onset, or later if new vesicles are still forming. Topical aciclovir cream is inadequate for zoster, and corticosteroids are not used alone and do not reliably prevent post-herpetic neuralgia.

   Reference: NICE Clinical Knowledge Summaries, Shingles (2023); American Academy of Ophthalmology guidance on herpes zoster ophthalmicus (2022)

8. Question 8 · Neurology, Ophthalmology, Renal-Urology, Haematology, Geriatrics and Palliative Care

   A 33-year-old woman presents with three weeks of increasing fatigue, gum bleeding, bruising over the shins and drenching night sweats. Full blood count shows haemoglobin 7.8 g/dL, white cells 2.1 x 10^9/L with neutrophils 0.4 x 10^9/L, and platelets 18 x 10^9/L; the laboratory comments that occasional blast cells are seen on the film. She is afebrile today. What is the most appropriate action?

   1. APrescribe tranexamic acid and oral iron and repeat the count in one week
   2. BImmediate same-day discussion with and referral to haematology for urgent assessment
   3. CRefer routinely to haematology and advise her to attend if she develops a fever
   4. DStart broad-spectrum oral antibiotics and arrange a bone marrow biopsy as an outpatient in two weeks
   Show answer and explanation

   Correct answer: B. Immediate same-day discussion with and referral to haematology for urgent assessment

   Pancytopenia with circulating blasts and bleeding is a haematological emergency suggestive of acute leukaemia, and the combination of severe neutropenia and profound thrombocytopenia carries an immediate risk of overwhelming sepsis and haemorrhage, so same-day specialist assessment is mandatory. Repeating the count in a week or a routine referral would expose the patient to potentially fatal delay. Oral antibiotics do not cover neutropenic sepsis, which requires urgent intravenous therapy in hospital, and iron does not address marrow failure.

   Reference: NICE NG12 Suspected cancer: recognition and referral (updated 2023); British Society for Haematology Guidelines on the diagnosis and management of acute myeloid leukaemia (2021)

9. Question 9 · Endocrinology, Diabetes and Metabolic Disorders

   A 74-year-old asymptomatic woman with ischaemic heart disease has a TSH of 6.9 mIU/L with a normal free T4 on two occasions three months apart. Thyroid peroxidase antibodies are negative. What is the most appropriate management?

   1. AStart levothyroxine 100 micrograms daily immediately
   2. BStart carbimazole
   3. CRefer urgently for thyroid ultrasound and fine needle aspiration
   4. DObserve with periodic thyroid function testing, as treatment is generally not indicated at this TSH level in an asymptomatic older adult
   Show answer and explanation

   Correct answer: D. Observe with periodic thyroid function testing, as treatment is generally not indicated at this TSH level in an asymptomatic older adult

   Subclinical hypothyroidism with TSH below 10 mIU/L in an asymptomatic older adult, particularly with cardiac disease, is usually managed by monitoring, since trials such as TRUST showed no symptomatic or cardiovascular benefit from levothyroxine and TSH rises modestly with normal ageing. A full replacement dose in an elderly cardiac patient risks angina and arrhythmia, carbimazole treats hyperthyroidism, and imaging is indicated for a nodule or goitre, not for an isolated mildly raised TSH.

   Reference: Stott et al., TRUST trial, New England Journal of Medicine (2017); American Thyroid Association Guidelines for Hypothyroidism in Adults (2014)

10. Question 10 · Women's Health, Obstetrics and Gynaecology

    A 16-year-old presents with primary amenorrhoea. She has normal breast development, sparse pubic and axillary hair, a short blind-ending vagina, and no palpable uterus on ultrasound. Serum testosterone is within the adult male reference range and LH is elevated. What is the most likely diagnosis?

    1. AComplete androgen insensitivity syndrome
    2. BMayer-Rokitansky-Kuster-Hauser syndrome
    3. CTurner syndrome (45,X)
    4. DCongenital adrenal hyperplasia due to 21-hydroxylase deficiency
    Show answer and explanation

    Correct answer: A. Complete androgen insensitivity syndrome

    Normal breast development with absent or sparse sexual hair, an absent uterus and male-range testosterone with elevated LH is the classic picture of complete androgen insensitivity in a 46,XY individual, where peripheral aromatisation of testosterone drives breast growth while androgen receptor failure prevents sexual hair and Wolffian development, and anti-Mullerian hormone from the testes causes Mullerian regression. In Mayer-Rokitansky-Kuster-Hauser syndrome the uterus is absent but pubic hair and testosterone are normal female. Turner syndrome causes delayed puberty with a small uterus and elevated FSH, and congenital adrenal hyperplasia causes virilisation with a present uterus.

    Reference: Williams Gynecology, 4th edition (2020); ESPE/LWPES Consensus Statement on Management of Disorders of Sex Development (2006)

11. Question 11 · Musculoskeletal Medicine, Rheumatology, Orthopaedics and Sports Medicine

    A 74-year-old woman with a 3-month history of shoulder and hip girdle stiffness on prednisolone 15 mg daily reports 2 days of new right temporal headache, scalp tenderness when combing her hair, and jaw pain when chewing. Vision is currently normal. ESR is 88 mm/h. What is the most appropriate immediate action?

    1. AContinue the current dose and arrange temporal artery ultrasound within 2 weeks
    2. BIncrease prednisolone to a high dose (40-60 mg daily) immediately and refer urgently for same-day specialist assessment
    3. CAdd low-dose aspirin and review in 1 week
    4. DStop prednisolone and arrange temporal artery biopsy before any further treatment
    Show answer and explanation

    Correct answer: B. Increase prednisolone to a high dose (40-60 mg daily) immediately and refer urgently for same-day specialist assessment

    New temporal headache, scalp tenderness and jaw claudication in a patient with polymyalgia rheumatica indicate giant cell arteritis, which threatens irreversible blindness from anterior ischaemic optic neuropathy within days. High-dose glucocorticoid must be started immediately, without waiting for imaging or biopsy, and urgent specialist review arranged. Biopsy or ultrasound remains informative for up to about 1-2 weeks after starting steroids, so treatment must never be delayed or withheld for the test.

    Reference: BSR Guideline for the diagnosis and treatment of giant cell arteritis (2020); EULAR recommendations for the management of large vessel vasculitis (2018)

12. Question 12 · Acute and Emergency Care, Minor Surgery and Procedural Skills

    A 4-year-old boy weighing 18 kg develops anaphylaxis after eating a cashew nut at nursery and is brought to your clinic with wheeze and hypotension. What is the correct intramuscular adrenaline dose, and what is the appropriate minimum observation period after treatment if he responds promptly and has no risk features?

    1. A300 micrograms; observe for 1 hour
    2. B500 micrograms; observe for 2 hours
    3. C50 micrograms; observe for 12 hours
    4. D150 micrograms; observe for at least 2 hours, extending to 6-12 hours if risk features are present
    Show answer and explanation

    Correct answer: D. 150 micrograms; observe for at least 2 hours, extending to 6-12 hours if risk features are present

    For children aged 6 months to 6 years the intramuscular adrenaline dose is 150 micrograms (0.15 mL of 1:1000), rising to 300 micrograms for 6-12 years and 500 micrograms from 12 years. Current guidance permits discharge after a minimum of 2 hours in a child who responds rapidly to a single dose and has no risk features, with 6-12 hours of observation when there was a severe reaction, a need for more than one dose, or a history of biphasic reaction or asthma. The 300 and 500 microgram doses are for older children and adults respectively, and 50 micrograms is not a recognised anaphylaxis dose.

    Reference: Resuscitation Council UK, Emergency Treatment of Anaphylaxis, 2021; EAACI Anaphylaxis Guideline update, 2021

Family Medicine reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Family Medicine questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.